2. Automatic Absentee Voter Application List Request Form
4. You must be registered to vote in the City of Portland to apply with this form.
6. First Name
7. Last Name
9. Address1
11. Address2
13. City
14. State
15. Zip
17. Email Address
19. By submitting this form, I certify I am the registered voter listed and wish to be on the permanent absent voter list.
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field